Early Albumin Exposure After Cardiac Surgery

Expert consensus on the use of human serum albumin in adult cardiac surgery

“…The intervention was also associated with a decreased median overall dose of norepinephrine (median: 19 vs. 47, P =0.025) and a shorter median time to cessation of norepinephrine (median: 17 h vs. 28 h, P =0.002). [ 13 , 58 , 59 ] Another retrospective study by Thang et al [ 60 ] included 8136 cardiac surgical patients and showed that 4444 (54.6%) patients who received HSA during the first 24 h of intensive care unit admission had significantly lower adjusted mortality than patients who did not (OR, 0.68; 95% CI, 0.48–0.97; P <0.05). As a result, there is a growing interest in the utility of HSA to avoid over-resuscitation and an excessive positive fluid balance in patients undergoing cardiac surgery.…”

“…Despite the efficacy of crystalloids in volume expansion, no consistent evidence has shown that resuscitation with albumin improves operative outcomes in patients undergoing cardiac surgery. [ 58 , 60 , 67 , 68 ] As mentioned above, the ALBICS trial failed to demonstrate any significant benefits by HSA infusion as the first-line choice of fluid resuscitation regarding major morbid outcomes in patients who underwent cardiac surgery compared with crystolloids. [ 32 ] In addition, the University of Maryland Medical Center restricted its albumin use in 2015 only to patients requiring more than 3 liter of crystalloid infusion in the first 24 h after cardiac surgery, hypoalbuminemia (serum albumin concentrations <30 g/L), or patients considered to have fluid overload (central venous pressure >5 mmHg, pulmonary artery diastolic pressure >20 mmHg, and pulmonary edema).…”